Perspektif Teoritik

Talcott Parsons
The Post Parsons Era
Period of Maturity: 1970–2000

Medical sociology is a subdiscipline of sociology that studies the social causes and
consequences of health and illness (Cockerham 2004). Major areas of investigation include
the social aspects of health and disease, the social behavior of health care workers and the
people who utilize their services, the social functions of health organizations and institutions,
the social pat terns of health services, the relationship of health care delivery systems to other
social systems, and health policy. What makes medical sociology important is the significant
role social factors play in determining the health of individuals, groups, and the larger
society. Social conditions and situations not only cause illness, but they also help prevent it.
In recognition of the broad impact of social factors on health, medical sociology is sometimes
referred to as ‗‗health sociology‘‘ or the ‗‗sociology of health.‘‘ However, the traditional
name ‗‗medical sociology‘‘ persists because it is preferred by many of its practitioners.
Medical sociologists comprise one of the largest groups of sociologists in the world. They
have employment opportunities both within and outside of academia. Medical sociologists
work not only in university sociology departments, medical, nursing, and public health
schools and various other health related professional schools, but also in research
organizations and government agencies.

Medical sociology is a relatively new socio logical specialty. It came of age in the late 1940s
and early 1950s in an intellectual climate far different from sociology‘s traditional specialties.
Specialties like theory, social stratification, urbanization, social change, and religion had
direct roots to nineteenth century European social thought. These specialties were grounded
in classical theory with major works by the sub discipline‘s founding figures. However,
sociology‘s early theorists ignored medicine because it was not an institution shaping society.
An exception is Emile Durkheim‘s Suicide (1951 [1897]), which is sometimes claimed as the
first major work in the field. Medical sociology appeared in strength only in the mid
twentieth century as an applied field in which sociologists could produce knowledge useful in
medical practice and developing public policy in health matters.

Moreover, physicians, not sociologists, produced much of the earliest literature in medical
sociology. In the United States, John Shaw Billings, organizer of the National Library of
Medicine and compiler of the Index Medicus, wrote about hygiene and sociology in 1879;
Charles McIntire defined medical sociology in 1894; Elizabeth Blackwell, the first woman to
graduate from an American medical school, published a collection of essays on medical
sociology in 1902, as did James Warbasse in 1909 (Bloom 2002). The most important
contribution came from Lawrence Henderson, a physician who taught a sociology course at
Harvard in the 1930s. Henderson espoused structural functionalist theory and published a
1935 work on the patient–physician relationship as a social system. Henderson‘s most direct
influence on medical sociology was through Talcott Parsons, one of his students who became
a leading figure in sociology (Bloom 2002). The first sociologist to publish extensively on
medical sociology was Bernhard Stern, who wrote historical accounts of the role of medicine
in society from the late 1920s until the early 1940s.

Medical sociology evolved as a specialty in sociology in response to funding agencies and

policymakers after World War II who viewed it as an applied field that could produce
knowledge for use in medical practice, public health campaigns, and health policy
formulation. Ample funding for research to help solve the health problems of industrial
society and the welfare state in the West during the post World War II era stimulated its
growth. In 1949, for example, the Russell Sage Foundation in the United States funded a
program to improve the utilization of social science in medical practice that resulted i n
books on social science and medicine and the role of sociology in public health.
Particularly important was the establishment of the National Institute of Mental Health
(NIMH) in the United States that funded and promoted cooperative projects between
sociologists and physicians. A significant result of such cooperation was the publication in
1958 of Social Class and Mental Illness: A Community Study by August Hollingshead (a
sociologist) and Frederick Redlich (a psychiatrist). This landmark study produced important
evidence that social factors were correlated with different types of mental disorders and
the manner in which people received psychiatric care. The book remains the seminal
study of the relationship between mental disorder and social class. This study also played a
key role in the
debate during the 1960s leading to the establishment of community mental health centers in
the United States.

At the beginning of medical sociology‘s expansion, many people in the field had tenuous
roots in mainstream sociology and an orientation toward applied rather than theoretical work.
Some had no training in medical sociology whatsoever. Many had been attracted to the
subdiscipline because of the availability of jobs and funding for research. This situation led
Robert Straus (1957) to suggest that medical sociology had become divided into two areas:
sociology in medicine and sociology of medicine.

The sociologist in medicine performed applied research and analysis primarily motivated by a
medical problem rather than a sociological problem. Sociologists in medicine typically
worked in medical, nursing, public health or similar professional schools, public health
agencies, or health organizations like CDC and WHO. Sociologists of medicine primarily
worked in academic sociology departments and engaged in research and analysis of health
from a socio logical perspective.
The division in orientation created problems in the United States. Medical sociologists in
universities were in a stronger position to produce work that satisfied sociologists as good
sociology. Sociologists in medical institutions had the advantage of participation in medicine
as well as research opportunities unavailable to those outside clinical settings. Disagreement
developed between the two groups over whose work was the most important. What resolved
this situation over time was a general evolution in medical sociology that saw both applied
and theoretical work emerge on the part of medical sociologists in all settings. Medical
sociologists in universities responded to funding requests for applied research, while some of
their counter parts in medical institutions, like Anselm Strauss, produced important
theoretical work.

A related problem in the early development of medical sociology was its potent ial to
become dependent on medicine for its direction and research orientation. However, this did
not hap pen, as medical sociologists adopted an independent course and made the
practice of medicine one of its major subjects of inquiry, including its core relationships
with patients and the organizational structure of health care delivery systems (Bloom
2002). Medical sociologists, in turn, brought their own topics to the study of health such as
social stress, health lifestyles, and the social determinants of disease.
Talcott Parsons
A decisive event took place in medical sociology in 1951 that provided a theoretical direction
to a formerly applied field. This was the appearance of Parsons‘s The Social System. This
book, written to explain a complex structural functionalist model of society, contained
Parsons‘s concept of the sick role. Parsons had become the best known sociologist in the
world and having a theorist of his stature provide the first major theory in medical sociology
called attention to the young subdiscipline – particularly among academic sociologists.
Anything he published attracted interest. Not only was Parsons‘s concept of the sick role a
distinctly sociological analysis of sickness, but it was widely believed by many sociologists at
the time that Parsons was charting a future course for all of sociology through his theoretical
approach. This did not happen. Nevertheless, Parsons brought medical sociology intellectual
recognition that it needed in its early development by endowing it with t heory.
Moreover, following Parsons, other leading sociologists of the time such as Robert Merton
and Erving Goffman published work in medical sociology that further promoted the
academic legitimacy of the field.

The Post Parsons Era

The next major area of research after Parsons developed his sick role concept was medical
education. Merton and his colleagues (1957) extended the structural functionalist mode of
analysis to the socialization of medical students, with Renee Fox‘s paper on training for
uncertainty ranking as a major contribution. Four years later, Howard Becker and his
associates published Boys in White (1961), a study of medical school socialization conducted
from a symbolic interactionist perspective. This study became a sociological classic a nd
was important for both its theoretical and methodological con tent. The techniques in
participant observation provided a basis for the seminal work on death and dying and
subsequent innovations in theory and methods by Barney Glaser and Anselm Strauss (1965,
1967).
With the introduction of symbolic interaction into a field that had previously been dominated
by structural functionalism, medical sociology became a significant arena of debate between
two of sociology‘s major theoretical schools. This debate helped stimulate a virtual flood of
publications in medical sociology in the 1960s. Moreover, the Medical Sociology Section of
the American Sociological Association (ASA) was formed in 1959 and grew to become one
of the largest and most active ASA sections. American influence was also important in
founding Research Committee 15 (Health Sociology) of the International Sociological
Association in 1967 (Bloom 2002). The Medical Sociology Group of the British Sociological
Association (BSA) was organized in 1964 and became the largest specialty group in the BSA,
with its own annual conference.

In 1966 the Journal of Health and Social Behavior, founded in 1960, became an official ASA
publication, making medical sociology one of the few sociological subdisciplines publishing
its own journal under ASA auspices. In the meantime, in Great Britain, a new journal, Social
Science and Medicine, was founded in 1967 and became an especially important journal for
medical sociologists throughout the world. The growing literature in medical sociology also
led to the publication of textbooks. The first textbook was Norman Hawkins‘s Medical
Sociology (1958), but the early leaders were the first editions of books by David Mechanic
(1968) and Rodney Coe (1970). Howard Free man, Sol Levine, and Leo Reeder likewise
made an important contribution by publishing the Handbook of Medical Sociology, which
contained summary essays on major topics by leading medical sociologists. The first edition
appeared in 1963 and the fifth edition in 2000, edited by Chloe Bird, Peter Conrad, and Allen
Fremont.
During the 1960s, the symbolic interaction ist perspective temporarily dominated a
significant portion of the literature. One feature of this domination was the numerous studies
conducted with reference to labeling theory and the mental patient experience. Sociologists
expanded their work on mental health to include studies of stigma, stress, families coping
with mental disorder, and other areas of practical and theoretical relevance. For
example, Goff man‘s Asylums (1961), a study of life in a mental hospital, presented his
concept of
‗‗total institutions‘‘ that stands as a significant sociological statement about social life in an
externally controlled environment. An abundant literature emerged at this time that
established the sociology of mental disorder as a major subfield within medical sociology
(Cockerham 2006).

Period of Maturity: 1970–2000

Between 1970 and 2000 medical sociology emerged as a mature sociological subdiscipline.
This period was marked by the publication of two especially important books, Eliot
Friedson‘s Professional Dominance (1970) and Paul Starr‘s The Social Transformation of
American Medicine (1982). Friedson formulated his influential ‗‗professional dominance‘‘
theory to account for an unprecedented level of professional control by physicians over health
care delivery that was true at the time but no longer exists. Starr‘s book won the Pulitzer
Prize and countered Friedson‘s thesis by examining the decline in status and professional
power of the medical profession as large corporate health care delivery systems oriented
toward profit effectively entered an unregulated medical market. Donald Light (1993)
subsequently used the term ‗‗countervailing power‘‘ to show how the medical profession was
but one of many powerful groups in society – the state, employers, health insurance
companies, patients, pharmaceutical and other companies providing medical products –
maneuvering to fulfill its interests in health care.

Another major work was Bryan Turner‘s Body and Society (1984), which initiated the
sociological debate on this topic. Theoretical developments concerning the sociological
understanding of the control, use, and phenomenological experience of the body, including
emotions, followed. Much of this work has been carried out in Great Britain and features
social constructionism as its theoretical foundation. Social constructionism has its origins in
the work of the French social theorist Michel Foucault and takes the view that knowledge
about the body, health, and illness reflects subjective, historically specific human concerns
and is subject to change and reinterpretation. Other areas in which British medical
sociologists have excelled include studies of medical practice, emotions, and the experience
of illness. Medical sociology also became a major socio logical specialty in Finland, the
Netherlands, Germany, Italy, Spain, and Israel, and began to emerge in Russia and Eastern
Europe in the 1990s after the collapse of communism. In the meantime, the European Society
for Health and Medical Sociology was formed in 1983 and hosts a biannual conference for
European medical sociologists. In Japan, the Japanese Society for Medical Sociology was
established in 1974 and, since 1990, has published an annual review of work in the field.
Elsewhere in Asia, medical sociology is especially active in Singapore, Thailand, and India,
and is beginning to appear in China. In Africa, medical sociology is strongest in South Africa.
Medical sociology is also an important field in Latin America, and because of its special
Latin character, many practitioners prefer to publish their work in books and journals in
Mexico, Brazil, Argentina, and Chile (Castro 2000).

From the 1970s through the 1990s, medical sociology flourished as it attracted large numbers
of practitioners in both academic and applied settings and sponsored an explosion of
publications based upon empirical research. Major areas of investigation included stress, the
medicalization of deviance, mental health, inequality and class differences in health, health
care utilization, managed care and other organizational changes, AIDS, and women‘s health
and gender. Several books, edited collections of readings, and textbooks appeared. The
leading reader was edited by Peter Conrad and Rochelle Kern in 1981 and is now in a seventh
edition (2005), with Conrad the sole editor. The leading textbook was William Cockerham‘s
Medical Sociology, first published in 1978 and due to appear in a tenth edition in 2007.
Another major medical sociology journal, the Sociology of Health and Illness, was started in
Britain in 1978, as was a new journal, Health, in 1999.

However, the success of medical sociology also brought problems in the 1980s. Research
funding opportunities lessened and the field faced serious competition for existing resources
with health economics, health psychology, medical anthropology, health services research,
and public health. Not only did these fields adopt sociological research methods in t he
forms of social surveys, participation observation, and focus groups, some also employed
medical sociologists in large numbers. While these developments were positive in many
ways, the distinctiveness of medical sociology as a unique subdiscipline was nevertheless
challenged as other fields moved into similar areas of research. Furthermore, some of the
medical sociology programs at leading American universities had declined or disappeared
over time as practitioners retired or were hired away. Yet the overall situation for medical
sociology was positive as the job market remained good, almost all graduate programs in
sociology offered a specialization in medical sociology, and sociologists were on the
faculties of most medical schools in the United States, Canada, and Western Europe (Bloom
2002).

The 1990s saw medical sociology move closer to its parent discipline of sociology. This was
seen in a number of areas, with medical socio logical work appearing more frequently in
general sociology journals and the increasing application of sociological theory to the
analysis of health problems. The American Journal of Sociology published a special issue on
medical sociology in 1992, and papers on health related topics are not unusual in the
American Sociological Review. While medical sociology drew closer to sociology, sociology
in turn moved closer to medical sociology as the field remains one of the largest and most
robust sociological specialties.

The Present
Ultimately, what allows medical sociology to retain its unique character is (1) its utilization
and mastery of sociological theory in the study of health and (2) the sociological perspective
that accounts for collective causes and outcomes of health problems and issues. No other
field is able to bring these skills to health related research and analysis. Today it can be said
that medical sociology produces literature intended to inform medicine and policymakers, but
research in the field is also grounded in examining health related situations that inform
sociology as well. Medical sociology no longer functions as a field whose ties to the mother
discipline are tenuous, nor has it evolved as an enterprise subject to medical control. It now
works most often with medicine in the form of a partner and, in some cases, an objective critic.
Moreover, medical sociology owes more to medicine than to sociology for its origin and
initial financial support, so the relationship that has evolved is essentially supportive. As
medical sociology continues on its present course, it is likely to emerge as one of sociology‘s
core specialties as the pursuit of health increasingly becomes important in everyday social
life.